跟骨骨折内固定术后切口并发症的临床分析.docVIP

跟骨骨折内固定术后切口并发症的临床分析 　　[摘要] 目的 分析跟骨关节内骨折术后切口皮瓣坏死等并发症的原因，探讨避免跟骨术后切口皮瓣愈合不良的策略。方法 2010年3月―2014年11月，该院共收治跟骨骨折患者53例，均行切开复位钢板内固定术。手术时间7～14 d，均采取跟骨外侧入路，跟骨解剖钛板固定，术后12号硅胶引流管经足背戳孔置入并负压引流，切口无需弹力绷带加压包扎。 结果 1例患者术后出现切口并发症，为切口皮瓣坏死，发病率为1.9%。经清创换药后皮肤缺损并内固定物外露，再次手术行腓肠神经逆行岛状皮瓣闭合创面。 结论 选择合适手术时间窗、手术操作规范轻柔、充分引流是有效减少切口并发症的关键。 中国论文网 /6/view-7216856.htm 　　[关键词] 跟骨骨折；手术方法；切口并发症 　　[中图分类号] R276.7 [文献标识码] A [文章编号] 1674-0742（2016）01（a）-0042-03 　　Clinical Analysis of the Wound Complications after Calcaneal Fracture with Internal Fixation 　　GU Wei 　　Department of Orthopedics， Chinese Medicine Hospital of Qijiang District， Chongqing， Chongqing， 401420 China 　　[Abstract] Objective To analyze the causes of incision skin flap necrosis after intra-articular calcaneal fracture surgery and explore the measures for improving the healing of incision skin flap after calcaneal fracture surgery. Methods A total of 53 cases with calcaneal fracture admitted in our department from March 2010 to November 2014 were given open reduction and internal fixation with plate. Timing of surgery 7-14 days. All the patients were treated by lateral approach to calcaneus and titanium plate fixation， postoperative negative pressure drainage via the No. 12 silicone drainage tube inserted in the dorsal puncture， and the incision without elastic bandage. Results The complication such as incision skin flap necrosis occurred in 1 case after surgery， with the incidence was 1.9%. After debridement and dressing， the skin appeared defect and the internal fixator exposed， but the wound was closed after the second surgery of sural nerve reverse island skin flap repairing. Conclusion The appropriate time for operation， gentle surgical practices， and adequate drainage are the key to reducing the wound complications. 　　[Key words] Calcaneal fracture； Surgical method； Wound complications 　　跟骨关节内骨折十分常见，占跟骨骨折的70%，伤者多为青壮年，严重损伤时易致残 。对于跟骨关节内骨折，公认经足跟外侧“L”形切口入路可以获得距下关节面的良好显露，直视下容易将跟骨关节内骨折解剖复位，坚强内固定，早期功能锻炼，患者预后一般均较好。因跟骨形态不规则，解剖结构复杂，对医师技术要求较高，